TriZetto’s TPA Solution Release Supports ICD-10 Compliance; Mercy Benefit Administrators Completes Rapid, Smooth Upgrade

TriZetto’s TPA Solution Release Supports ICD-10 Compliance; Mercy Benefit Administrators Completes Rapid, Smooth Upgrade

Schwartz MSL BostonDavida Dinerman/Maggie Fairchild, 781-684-0770orTriZetto CorporationLoren Finkelstein, 303-542-2460

today announced the general availability of the 5.00 version of its enterprise , the platform used most widely by the nation’s (TPAs). The healthcare IT company also announced a rapid, successful upgrade to the new version by Springfield, Mo.-based . The TPA administers the self-funded medical claims of approximately 8,300 members who are primarily patients of Mercy, the country’s sixth-largest Catholic healthcare system.

TriZetto’s QicLink solution helps benefit administrators reduce costs through greater automation, increased auto-adjudication and reduced manual intervention in claims processing. The new 5.00 version of the system supports compliance, providing data load, maintenance and inquiry functionality for TPAs migrating to the greatly expanded diagnosis and procedure code set. The solution also enables ICD-10/ICD-9 crosswalk and code translation.

“Our early conversion to TriZetto’s QicLink 5.00 release allows us to incorporate the advantages of the product into our marketing efforts this summer, well ahead of open enrollment,” said Jennifer Johnson, manager of claims administration for Mercy Benefit Administrators. “The ICD-10 readiness of TriZetto’s platform puts us one step ahead of many others. It’s a differentiator that can drive RFPs and help win new customers. The new version of TriZetto’s solution gives us an edge when we promote our products and services at conferences.”

Johnson said TriZetto’s enterprise system “positions Mercy Benefit Administrators as a leader in ICD-10.” The solution syncs the TPA with the compliance initiative of Mercy health system, she added, as well as with the provider’s innovative model of care delivery and strategy as an accountable care organization. “Now, with our enterprise technology well in hand, we can focus fully on customer service. With the enhanced functionality of TriZetto’s solution, Mercy Benefit Administrators can say ‘We are’ instead of ‘We will,’” said Johnson.

Completed in just hours and five days ahead of schedule, the system upgrade “was one of the smoothest in my experience, with everyone on top of their game and giving 110 percent,” Johnson said. Scott Ray, TriZetto’s senior vice president of benefits administration services and application management services, concurs.

“It was a truly collaborative, highly successful effort, with our TriZetto upgrade team working in close coordination with the IS group and others throughout the Mercy organization,” he said. “At any given time, each team knew what the other was working on, which items had been completed and which ones were outstanding. We greatly appreciate Mercy Benefit Administrators’ partnership in our field trials of the new 5.00 platform. We are extremely excited to report an early go-live of the release and general availability of the 5.00 platform, delivered on time and with very high quality,” said Ray.

The 5.00 release of TriZetto’s QicLink enterprise solution enables clients with the clinical-editing module to define edits by network. This capability allows benefit administrators to apply different rules and actions for specific in-network claims than those for other in-network and out-of-network claims. Additionally, the 5.00 version offers a consumer-directed healthcare module that requires no adapter hardware or software to enable real-time web service requests and responses.

: TriZetto TPA solutions helps Mercy Benefit Administrators comply with #ICD-10 with QicLink 5.00 #compliance #healthcareIT

Mercy Benefit Administrators is a full-service third-party administrator based in Springfield, Mo., providing a comprehensive range of self-funded health benefit administration, COBRA administration and network pricing. Direct contracts to an extensive network with award-winning facilities give clients the best network savings solutions available.

TriZetto delivers world-class information solutions that enable healthcare organizations to work more efficiently and to deliver better health. Its solutions reach 200,000 care providers, streamline processes for more than 360 payers and touch over half the U.S. insured population. TriZetto solutions help increase , , and succeed in the retail healthcare market. Its solutions help and execute strategies for . TriZetto’s healthcare experience, innovative solutions and comprehensive services help simplify healthcare for everyone. For more information, visit .

Suggested Articles

Blue Shield of California is teaming up with Accolade to offer self-insured employers a personalized way to connect with members about their benefits.

After spending the past three years leading technology strategy at HHS, Ed Simcox left to help grow a startup focused on precision medicine.

Apple is pushing deeper into health research with a new study leveraging the Apple Watch and smartphone apps.